Organization
LAVENDAR N LACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY ANN OSTENDORF (OWNER)
(815) 235-1551
Entity
Organization
Contact information
Practice address
755 W GALENA AVE, FREEPORT, IL 61032-3975
(815) 235-1551
(815) 235-1551
Mailing address
755 W GALENA AVE, PO BOX 655, FREEPORT, IN 61032-0655
(815) 235-1551
(815) 235-1551
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/22/2008
Last updated
05/22/2008
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